Provider Demographics
NPI:1952760563
Name:INTEGRATIVE CHIROPRACTIC GROUP, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE CHIROPRACTIC GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-215-9212
Mailing Address - Street 1:8014 W 149TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2712
Mailing Address - Country:US
Mailing Address - Phone:803-317-8099
Mailing Address - Fax:
Practice Address - Street 1:5600 W 95TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2921
Practice Address - Country:US
Practice Address - Phone:913-215-9212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty